Minority and Women-Owned Business Enterprise (M/WBE) Participation Goals Pursuant to Article 15-A of the New York State Executive Law The following M/WBE requirements apply when an applicant submits an application for grant funding that exceeds $25,000 for the full grant period. All forms referenced here can be found in the M/WBE Documents section at the end of this RFP. All applicants are required to comply with NYSED s Minority and Women-Owned Business Enterprises (M/WBE) policy. Compliance can be achieved by one of the three methods described below. Full participation by meeting or exceeding the M/WBE participation goal for this grant is the preferred method. M/WBE participation includes services, materials, or supplies purchased from minority and women-owned firms certified with the NYS Division of Minority and Women Business Development. Not-for-profit agencies are not eligible for this certification. For additional information and a listing of currently certified M/WBEs, see https://ny.newnycontracts.com/frontend/vendorsearchpublic.asp?tn=ny&xid=4687 The M/WBE participation goal for this grant is 20% of each applicant s total discretionary non-personal service budget over the entire term of the grant. Discretionary non-personal service budget is defined as total budget, excluding the sum of funds budgeted for: 1. direct personal services (i.e., professional and support staff salaries) and fringe benefits; and 2. rent, lease, utilities and indirect costs, if these items are allowable expenditures. For multi-year grants, applicants should use the total budget for the full multi-year term of the grants in the above calculation. The M/WBE Goal Calculation Worksheet is provided for use in calculating the dollar amount of the M/WBE goal for this grant application. M/WBE participation does not need to be the same for each year of a multi-year grant. All requested information and documentation should be provided at the time of submission. If this cannot be done, the applicant will have thirty days from the date of notice of award to submit the necessary documents and respond satisfactorily to any follow-up questions from the Department. Failure to do so may result in loss of funding. METHODS TO COMPLY An applicant can comply with NYSED s M/WBE policy by one of three methods: 1
1.Full Participation - This is the preferred method of compliance. Full participation is achieved when an applicant meets or exceeds the participation goals for this grant. COMPLETE FORMS: M/WBE Goal Calculation Worksheet M/WBE Cover Letter M/WBE 100 Utilization Plan M/WBE 102 Notice of Intent to Participate 2. Partial Participation, Partial Request for Waiver - This is acceptable only if good faith efforts to achieve full participation are made and documented, but full participation is not possible. COMPLETE FORMS: M/WBE Goal Calculation Worksheet M/WBE Cover Letter M/WBE 100 Utilization Plan M/WBE 101 Request for Waiver M/WBE 102 Notice of Intent to Participate M/WBE 105 Contractor s Good Faith Efforts 3. No Participation, Request for Complete Waiver - This is acceptable only if good faith efforts to achieve full or partial participation are made and documented, but do not result in any participation by M/WBE firm(s). COMPLETE FORMS: M/WBE Goal Calculation Worksheet M/WBE Cover Letter M/WBE 101 Request for Waiver M/WBE 105 Contractor s Good Faith Efforts GOOD FAITH EFFORTS Applicants must make a good faith effort to solicit NYS certified M/WBE firms as subcontractors and/or suppliers to achieve the goals for this grant. Solicitations may include, but are not limited to: advertisements in minority and womencentered publications; solicitation of vendors found in the NYS Directory of Certified Minority and Women-Owned Business Enterprises (see https://ny.newnycontracts.com/frontend/vendorsearchpublic.asp?tn=ny&xid= 4687); and the solicitation of minority and women-oriented trade and labor organizations. Good faith efforts include actions such as setting up meetings or announcements to make M/WBEs aware of supplier and subcontracting opportunities, identifying logical areas of the grant project that could be subcontracted to M/WBE firms, and utilizing all current lists of M/WBEs who are available for and may be interested in subcontracting or supplying goods for the project. 2
Applicants should document their efforts to comply with the stated M/WBE goals and submit this with their applications as evidence. Examples of acceptable documentation can be found in form M/WBE 105, Contractor s Good Faith Efforts. NYSED reserves the right to reject any application for failure to document good faith efforts. REQUEST FOR WAIVER When full participation cannot be achieved, applicants must submit a Request for Waiver (M/WBE 101). Requests for Waivers must be accompanied by documentation explaining the good faith efforts made and reasons they were unsuccessful in obtaining M/WBE participation. NYSED reserves the right to approve the addition or deletion of subcontractors or suppliers to enable applicants to comply with the M/WBE goals, provided such addition or deletion does not impact the technical proposal and/or increase the total budget. All payments to Minority and Women-Owned Business Enterprise subcontractor(s) should be reported to the NYSED M/WBE Program Unit using the M/WBE 103 Quarterly M/WBE Compliance Report. This report should be submitted on a quarterly basis and can be found at www.oms.nysed.gov/fiscal/mwbe/forms.html. NYSED s M/WBE Coordinator is available to assist applicants in meeting the M/WBE goals. The Coordinator can be reached at MWBE@mail.nysed.gov. Equal Employment Opportunity Reporting (EEO) Pursuant to Article 15-A of the New York State Executive Law Applicants must complete and submit form EEO 100: Staffing Plan. M/WBE Documents Package (original signatures required) Full Participation Request Partial Waiver Request Total Waiver Forms Required Type of Form Full Participation Request Partial Waiver Request Total Waiver Calculation of M/WBE Goal Amount M/WBE Cover Letter M/WBE 100 Utilization Plan M/WBE 102 Notice of Intent to Participate M/WBE 105 Contractor s Good Faith Efforts M/WBE 101 Request for Waiver Form and Instructions EE0 100 Staffing Plan and Instructions N/A N/A N/A N/A 3
M/WBE Documents M/WBE Goal Calculation Worksheet (This form should reflect Budget Summary Totals) RFP # and Title: Applicant Name: The M/WBE participation for this grant is 20% of each applicant s total discretionary nonpersonal service budget over the entire term of the grant. Discretionary non-personal service budget is defined as the total budget, excluding the sum of funds budgeted for direct personal services (i.e., professional and support staff salaries) and fringe benefits, as well as rent, lease, utilities, and indirect costs, if these are allowable expenditures. Please complete the following table to determine the dollar amount of the M/WBE goal for this grant application. Budget Category 1. Total Budget 2. Professional Salaries 3. Support Staff Salaries 4. Fringe Benefits 5. Indirect Costs 6. Rent/Lease/Utilities* Amount budgeted for items excluded from M/WBE calculation Totals 7. Sum of lines 2, 3,4,5, and 6 8. Line 1 minus Line 7 M/WBE Goal 9. percentage (20%) Line 8 multiplied by 10. Line 9 =MWBE goal amount *If not included in #5 0.20 19
M/WBE COVER LETTER Minority & Woman-Owned Business Enterprise Requirements NAME OF GRANT PROGRAM NAME OF APPLICANT In accordance with the provisions of Article 15-A of the NYS Executive Law, 5 NYCRR Parts 140-145, Section 163 (6) of the NYS Finance Law and Executive Order #8 and in fulfillment of the New York State Education Department (NYSED) policies governing Equal Employment Opportunity and Minority and Women-Owned Business Enterprise (M/WBE) participation, it is the intention of the New York State Education Department to provide real and substantial opportunities for certified Minority and Women-Owned Business Enterprises on all State contracts. It is with this intention the NYSED has assigned M/WBE participation goals to this contract. In an effort to promote and assist in the participation of certified M/WBEs as subcontractors and suppliers on this project for the provision of services and materials, the bidder is required to comply with NYSED s participation goals through one of the three methods below. Please indicate which one of the following is included with the M/WBE Documents Submission: Full Participation No Request for Waiver (PREFERRED) Partial Participation Partial Request for Waiver No Participation Request for Complete Waiver By my signature on this Cover Letter, I certify that I am authorized to bind the Bidder s firm contractually. Typed or Printed Name of Authorized Representative of the Firm Typed or Printed Title/Position of Authorized Representative of the Firm Signature/Date 20
M/WBE UTILIZATION PLAN INSTRUCTIONS: All bidders/applicants submitting responses to this procurement/project must complete this M/WBE Utilization Plan unless requesting a total waiver and submit it as part of their proposal/application. The plan must contain detailed description of the services to be provided by each Minority and/or Women-Owned Business Enterprise (M/WBE) identified by the bidder/applicant. Bidder/Applicant s Name Telephone/Email: / Address Federal ID No.: City, State, Zip RFP No.: Certified M/WBE Classification (check all applicable) Description of Work (Subcontracts/Supplies/Services) Annual Dollar Value of Subcontracts/Supplies/Services NAME NYS ESD Certified ADDRESS CITY, ST, ZIP MBE WBE $ PHONE/E-MAIL FEDERAL ID No. NAME NYS ESD Certified ADDRESS CITY, ST, ZIP MBE WBE $ PHONE/E-MAIL FEDERAL ID No. PREPARED BY (Signature) DATE SUBMISSION OF THIS FORM CONSTITUTES THE BIDDER/APPLICANT S ACKNOWLEDGEMENT AND AGREEMENT TO COMPLY WITH THE M/WBE REQUIREMENTS SET FORTH UNDER NYS EXECUTIVE LAW, ARTICLE 15-1, 5 NYCRR PART 143 AND THE ABOVE REFERENCE SOLICITATION. FAILURE TO SUBMIT COMPLETE AND ACCURATE INFORMATION MAY RESULT IN A FINDING OF NONCOMPLIANCE AND/OR PROPOSAL/APPLICATION DISQUALIFICATION. NAME AND TITLE OF PREPARER: (print or type) TELEPHONE/E-MAIL DATE REVIEWED BY DATE UTILIZATION PLAN APPROVED YES/NO DATE NOTICE OF DEFICIENCY ISSUED YES/NO DATE NOTICE OF ACCEPTANCE ISSUED YES/NO DATE M/WBE 100
M/WBE SUBCONTRACTORS AND SUPPLIERS NOTICE OF INTENT TO PARTICIPATE INSTRUCTIONS: Part A of this form must be completed and signed by the Bidder/Applicant unless requesting a total waiver. Parts B & C of this form must be completed by MBE and/or WBE subcontractors/suppliers. The Bidder/Applicant must submit a separate M/WBE Notice of Intent to Participate form for each MBE or WBE as part of the proposal/application. Bidder/Applicant Name: Federal ID No.: Address: Phone No.: City State Zip Code E-mail: Signature of Authorized Representative of Bidder/Applicant s Firm Print or Type Name and Title of Authorized Representative of Bidder/Applicant s Firm Date: PART B - THE UNDERSIGNED INTENDS TO PROVIDE SERVICES OR SUPPLIES IN CONNECTION WITH THE ABOVE PROCUREMENT/APPLICATION: Name of M/WBE: Federal ID No.: Address: Phone No.: City, State, Zip Code E-mail: BRIEF DESCRIPTION OF SERVICES OR SUPPLIES TO BE PERFORMED BY MBE OR WBE: DESIGNATION: MBE Subcontractor WBE Subcontractor MBE Supplier WBE Supplier PART C - CERTIFICATION STATUS (CHECK ONE): The undersigned is a certified M/WBE by the New York State Division of Minority and Women-Owned Business Development (MWBD). The undersigned has applied to New York State s Division of Minority and Women-Owned Business Development (MWBD) for M/WBE certification. THE UNDERSIGNED IS PREPARED TO PROVIDE SERVICES OR SUPPLIES AS DESCRIBED ABOVE AND WILL ENTER INTO A FORMAL AGREEMENT WITH THE BIDDER/APPLICANT CONDITIONED UPON THE BIDDER/APPLICANT S EXECUTION OF A CONTRACT WITH THE NYS EDUCATION DEPARTMENT. The estimated dollar amount of the agreement $ Date M/WBE 102 Signature of Authorized Representative of M/WBE Firm Printed or Typed Name and Title of Authorized Representative
M/WBE CONTRACTOR GOOD FAITH EFFORTS CERTIFICATION (FORM 105) PROJECT/CONTRACT # I, (Bidder/Applicant) of (Title) (Company) ( (Address) ) (Telephone Number) do hereby submit the following as evidence of our good faith efforts to retain certified minority- and women-owned business enterprises: (1) Copies of its solicitations of certified minority- and women-owned business enterprises and any responses thereto; (2) If responses to the contractor s solicitations were received, but a certified minority- or woman-owned business enterprise was not selected, the specific reasons that such enterprise was not selected; (3) Copies of any advertisements for participation by certified minority- and women-owned business enterprises timely published in appropriate general circulation, trade and minority- or women-oriented publications, together with the listing(s) and date(s) of the publication of such advertisements; (4) Copies of any solicitations of certified minority- and/or women-owned business enterprises listed in the directory of certified businesses; (5) The dates of attendance at any pre-bid, pre-award, or other meetings, if any, scheduled by the State agency awarding the State contract, with certified minority- and women-owned business enterprises which the State agency determined were capable of performing the State contract scope of work for the purpose of fulfilling the contract participation goals; (6) Information describing the specific steps undertaken to reasonably structure the contract scope of work for the purpose of subcontracting with, or obtaining supplies from, certified minority- and womenowned business enterprises. (7) Describe any other action undertaken by the bidder to document its good faith efforts to retain certified minority - and women- owned business enterprises for this procurement. Submit additional pages as needed. Authorized Representative Signature Date M/WBE 105
M/WBE CONTRACTOR UNAVAILABLE CERTIFICATION RFP#/PROJECT NAME I, (Authorized Representative) (Title) (Bidder/Applicant s Company) ( (Address) ) (Phone) I certify that the following New York State Certified Minority/Women Business Enterprises were contacted to obtain a quote for work to be performed on the abovementioned project/contract. List of date, name of M/WBE firm, telephone/e-mail address of M/WBEs contacted, type of work requested, estimated budgeted amount for each quote requested. ESTIMATED DATE M/WBE NAME PHONE/EMAIL TYPE OF WORK BUDGET REASON 1. 2. 3. 4. 5. To the best of my knowledge and belief, said New York State Certified Minority/Women Business Enterprise contractor(s) was/were not selected, unavailable for work on this project, or unable to provide a quote for the following reasons: Please check appropriate reasons given by each MBE/WBE firm contacted above.) A. Did not have the capability to perform the work B. Contract too small C. Remote location D. Received solicitation notices too late E. Did not want to work with this contractor F. Other (give reason) Authorized Representative Signature Date Print Name M/WBE 105A
REQUEST FOR WAIVER FORM BIDDER/APPLICANT NAME: ADDRESS: CITY, STATE, ZIPCODE: TELEPHONE: EMAIL: FEDERAL ID NO.: RFP#/PROJECT NO.: INSTRUCTIONS: By submitting this form and the required information, the bidder/applicant certifies that Good Faith Efforts have been taken to promote M/WBE participation pursuant to the M/WBE goals set forth under this RFP/Contract. Please see Page 2 for additional requirements and document submission instructions. BIDDER/APPLICANT IS REQUESTING (check all that apply): MBE Waiver - A waiver of the MBE goal for this procurement is requested. Total Partial % WBE Waiver - A waiver of the WBE goal for this procurement is requested. Total Partial % Waiver Pending ESD Certification (check here if subcontractor or supplier is not certified M/WBE, but an application for certification has been filed with Empire State Development) Subcontractor/Supplier Name: Date of application filing: PREPARED BY (Signature): DATE: SUBMISSION OF THIS FORM CONSTITUTES THE BIDDER/APPLICANT'S ACKNOWLEDGEMENT AND AGREEMENT TO COMPLY WITH THE M/WBE REQUIREMENTS SET FORTH UNDER NYS EXECUTIVE LAW, ARTICLE 15-A, 5 NYCRR PART 143, AND THE ABOVE REFERENCED SOLICITATION. FAILURE TO SUBMIT COMPLETE AND ACCURATE INFORMATION MAY RESULT IN A FINDING OF NONCOMPLIANCE AND/OR PROPOSAL DISQUALIFICATION. NAME OF PREPARER: FOR AUTHORIZED USE ONLY TITLE OF PREPARER: TELEPHONE: EMAIL: REVIEWED BY: DATE: WAIVER GRANTED YES NO TOTAL WAIVER PARTIAL WAIVER ESD CERTIFICATION WAIVER NOTICE OF DEFICIENCY CONDITIONAL WAIVER COMMENTS: M/WBE 101
REQUIREMENTS AND DOCUMENT SUBMISSION INSTRUCTIONS When completing the Request for Waiver Form, please check all boxes that apply. To be considered, the Request for Waiver Form must be accompanied by documentation for items 1-11, as listed below. If a Waiver Pending ESD Certification is requested, please see Item 11 below. Copies of the following information and all relevant supporting documentation must be submitted along with the request. 1. A statement setting forth your basis for requesting a partial or total waiver. 2. The names of general circulation, trade association, and M/WBE-oriented publications in which you solicited certified M/WBEs for the purposes of complying with your participation goals. 3. A list identifying the date(s) that all solicitations for certified M/WBE participation were published in any of the above publications. 4. A list of all certified M/WBEs appearing in the NYS Directory of Certified Firms that were solicited for purposes of complying with your certified M/WBE participation levels. 5. Copies of notices, dates of contact, letters, and other correspondence as proof that solicitations were made in writing and copies of such solicitations, or a sample copy of the solicitation if an identical solicitation was made to all certified M/WBEs. 6. Provide copies of responses made by certified M/WBEs to your solicitations. 7. Provide a description of any contract documents, plans, or specifications made available to certified M/WBEs for purposes of soliciting their bids and the date and manner in which these documents were made available. 8. Provide documentation of any negotiations between you, the Bidder/Applicant and the M/WBEs undertaken for purposes of complying with the certified M/WBE participations goals. 9. Provide any other information you deem relevant which may help us in evaluating your request for a waiver. 10. Provide the name, title, address, telephone number and email address of the Bidder/Applicant's representative authorized to discuss and negotiate this waiver request. 11. Copy of notice of application receipt issued by Empire State Development (ESD). NOTE: Unless a Total Waiver has been granted, Bidder/Applicant will be required to submit all reports and documents pursuant to the provisions set forth in the procurement and/or contract, as deemed appropriate by NYSED, to determine M/WBE compliance.
Total Work Force Male Female White African-American or Black Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Two or More Races Disabled Veteran White African-American Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Two or More Races Disabled Veteran Applicant Name: Address: City, State, ZIP: EQUAL EMPLOYMENT OPPORTUNITY - STAFFING PLAN (Instructions on Page 2) Telephone: Federal ID No.: Project No: Report includes: Work force to be utilized on this contract OR Applicant s total work force Enter the total number of employees in each classification in each of the EEO-Job Categories identified. Race/Ethnicity - report employees in only one category Hispanic Not-Hispanic or Latino or Latino Male Female EEO - Job Categories Executive/Senior Level Officials and Managers First/Mid-Level Officials and Managers Professionals Technicians Sales Workers Administrative Support Workers Craft Workers Operatives Laborers and Helpers Service Workers TOTAL PREPARED BY (Signature): NAME AND TITLE OF PREPARER: EEO 100 (Print or type) DATE: TELEPHONE/EMAIL:
STAFFING PLAN INSTRUCTIONS General Instructions: All Bidders/Applicants in the proposal/application must complete an EEO Staffing Plan (EEO 100) and submit it as part of the package. Where the work force to be utilized in the performance of the State contract/project can be separated out, the Bidder/Applicant shall complete this form only for the anticipated work force to be utilized on the State contract/project. Where the work force to be utilized in the performance of the State contract/project cannot be separated out, the Bidder/Applicant shall complete this form for Bidder/Applicant's total work force. Instructions for Completing: 1. Enter the Project number that this report applies to, along with the name, address, and federal ID number of the Bidder. 2. Check the appropriate box to indicate if the work force being reported is just for the contract/project or the Bidder/Applicant s total work force. 3. Check off the appropriate box to indicate if the Bidder completing the report is the contractor or subcontractor. 4. Enter the total work force by EEO job category. 5. Break down the total work force by gender and race/ethnic background and enter under the heading Race/Ethnicity. Contact the M/WBE Coordinator, mwbe@mail.nyused.gov, if you have any questions. 6. Enter the name, title, phone number and email address for the person completing the form. Sign and date the form in designated areas. RACE/ETHNIC IDENTIFICATION For purposes of this form NYSED will accept the definitions of race/ethnic designations used by the federal Equal Employment Opportunity Commission (EEOC), as those definitions are described below or amended hereafter. (Be advised these terms may be defined differently for other purposes under NYS statutory, regulatory, or case law). Race/ethnic designations as used by the EEOC do not denote scientific definitions of anthropological origins. For the purposes of this report, an employee may be included in the group to which he or she appears to belong, identifies with, or is regarded in the community as belonging. The race/ethnic categories for this survey are: Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races. Disabled - Any person who has a physical or mental impairment that substantially limits one or more major life activity; has a record of such an impairment; or is regarded as having such an impairment Vietnam Era Veteran - a veteran who served at any time between and including January 1, 1963 and May 7, 1975. EEO 100
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